Why the proposed Health Care Homes are not about patient-centred care

Many of my patients ask for better quality of life, independence or patient-centred care. Patients also want their care teams to be on the same page. The government’s Health Care Home model seems to be about capitation and to some extent hospital avoidance, and may not address the needs of patients.

Data extraction
The government will be extracting patient data from general practice in various ways

Although the model has some elements that may reduce potentially avoidable hospitalisations, it does so half heartedly. Participating GP practices will likely have to categorise their patients using a data extraction tool based on the UK’s QAdmissions algorithm and the Hospital Admission Risk Profile (HARP) questionnaire.

The patient risk selection tool, which has not yet been released by the government, will be going through GP patient databases like a big vacuum cleaner to determine disease complexity and predicted demand for unplanned acute care services. Higher risk categories will attract a slightly higher practice payment.

What’s missing is just about everything else – in particular a comprehensive multi-pronged approach shared by primary care providers and hospitals, incentivising multidisciplinary patient-centred team care.

Capitation model

Although the government talks about a new bundled payment approach, practices are paid a lump sum per patient regardless of how many services the patient receives – as far as I know this is the definition of a capitation system.

How will the proposed model further improve the way care is delivered to people with chronic and complex health conditions? Will it incentivise multidisciplinary care? Does it reach across silos and improve communication? Is the proposed change of payment system in combination with a hospital avoidance risk stratification tool enough to deliver the comprehensive, coordinated care many of our patients need?

The government’s Health Care Homes model does not reflect the RACGP’s best practice model of the medical home, as outlined in the RACGP Vision for general practice and a sustainable healthcare system, released in September 2015.

The ‘biggest health reform in a generation’ did not receive extra funding from the government. I’m concerned that this is not yet the fundamental shift towards patient-focused healthcare as asked for by consumers and health professionals. What do you think?